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# Clobazam (Oral)
## Overview
Clobazam is a 1,5-benzodiazepine with anticonvulsant properties. It is primarily used as adjunctive therapy for seizures associated with Lennox-Gastaut syndrome (LGS).
## Primary Indications
* Adjunctive treatment of seizures in patients with Lennox-Gastaut syndrome (LGS).
## Adult Dosing
* **Initiation:** Typically start at 5 mg twice daily.
* **Titration:** Increase dose gradually based on response and tolerability, usually by 5 mg to 10 mg every week.
* **Maintenance:** Usual maintenance dose is 10 mg to 20 mg twice daily.
* **Maximum:** Maximum recommended dose is 20 mg twice daily (40 mg/day).
## Pediatric Dosing (2 years and older)
* **Initiation:** Typically start at 0.25 mg/kg twice daily (maximum 5 mg twice daily).
* **Titration:** Increase dose gradually based on response and tolerability, usually by 0.25 mg/kg to 0.5 mg/kg every week.
* **Maintenance:** Usual maintenance dose is 0.5 mg/kg to 1 mg/kg twice daily.
* **Maximum:** Maximum recommended dose is 1 mg/kg twice daily (not to exceed 40 mg/day).
## Dose Adjustments
* **Hepatic Impairment:** Use with caution. No specific dose adjustment guidelines are established, but consider lower starting doses and slower titration.
* **Renal Impairment:** Use with caution. No specific dose adjustment guidelines are established, but consider lower starting doses and slower titration.
## Contraindications
* Known hypersensitivity to clobazam or other benzodiazepines.
## Adverse Effects
Common adverse effects include somnolence, decreased appetite, constipation, irritability, aggression, and drooling. Serious adverse effects include severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis), withdrawal symptoms upon abrupt discontinuation, and potential for increased risk of suicidal thoughts or behavior.
## Key Drug Interactions
* **CNS Depressants:** Additive CNS depressant effects with alcohol, opioids, other benzodiazepines, sedating antihistamines, and antipsychotics.
* **CYP2C19 Inhibitors/Inducers:** Clobazam is metabolized by CYP2C19. Strong inhibitors (e.g., fluconazole) may increase clobazam levels, while inducers may decrease levels.
* **Other Anticonvulsants:** Potential for additive CNS effects or altered anticonvulsant efficacy.
## Monitoring
* Monitor for therapeutic response (seizure frequency).
* Monitor for adverse effects, particularly somnolence, behavioral changes, and signs of severe skin reactions.
* Monitor for signs of withdrawal if discontinuing.
* Consider monitoring for suicidal ideation.
## Clinical Pearls
* Clobazam can be taken with or without food.
* Due to the risk of severe skin reactions, educate patients/caregivers to discontinue clobazam and seek immediate medical attention if a rash develops.
* Withdrawal symptoms can occur upon abrupt discontinuation. Taper the dose gradually when discontinuing.
* The risk of suicidal thoughts or behavior is a boxed warning. Monitor for any new or worsening mental health symptoms.
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**Disclaimer:** This information is intended as a concise summary and does not replace a thorough review of the full prescribing information or consultation with a healthcare professional. Always verify current prescribing information for the most up-to-date recommendations.
